Ohio Health Department declares hepatitis A outbreak

From the Plain Dealer:

The Ohio Department of Health declared a statewide community outbreak of hepatitis A on Friday evening.

The declaration followed the reporting of 79 hepatitis A cases in Ohio so far this year, almost double the number reported in all of 2017, according to a release issued by the department.

Counties Affected.


When an Iowa Family Doctor Takes On the Opioid Epidemic

From the NY Times:

Opioid overdoses are killing so many Americans that demographers say they are likely behind a striking drop in life expectancy. Yet most of the more than two million people addicted to opioid painkillers, heroin and synthetic fentanyl get no treatment. Dr. Gastala, 33, is trying to help by folding addiction treatment into her everyday family medicine practice. She is one of a small cadre of primary care doctors who regularly prescribe buprenorphine, a medication that helps suppress the cravings and withdrawal symptoms that plague people addicted to opioids. If the country is really going to curb the opioid epidemic, many public health experts say, it will need a lot more Dr. Gastalas.

Intubating Elderly Patients

From the NY Times:

Analyzing 35,000 intubations of adults over age 65, data gathered from 262 hospitals between 2008 and 2015, Dr. Ouchi and his colleagues found that a third of those patients die in the hospital despite intubation (also called “mechanical ventilation”).

Of potentially greater importance to elderly patients — who so often declare they’d rather die than spend their lives in nursing homes — are the discharge statistics.

Only a quarter of intubated patients go home from the hospital. Most survivors, 63 percent, go elsewhere, presumably to nursing facilities.The study doesn’t address whether they face short rehab stays or become permanent residents.

But it does document the crucial role that age plays.

Medical Clearance of Psych Patients in the ED: Consensus Recommendations

From Psychiatry Advisor:

Recommendations for Medical Evaluation of Psychiatric Patients in the ED

Recommendation 1: Medical evaluation should be conducted with the aim of identifying potential medical etiology (medical mimics such as infection, encephalopathy, and substance abuse intoxication or withdrawal) and medical comorbidities requiring care but not directly related to the current psychiatric complaint (such as diabetes or chronic obstructive pulmonary disease).

“EDs should perform an appropriate medical screening exam and appropriate documentation for the presenting complaint,” wrote the recommendation authors. “If there is a question [about] whether the patient has delirium or a psychiatric disorder, this patient should be medically observed or hospitalized.”

Recommendation 2The following factors should prompt consideration of further medical assessment: new-onset psychiatric symptoms in patients age >45; age ≥65; presence of cognitive deficits or delirium; symptoms suggesting physical etiology, such as cough and fever; evidence of head injury or focal neurologic findings; substance intoxication or withdrawal, or recent exposure to drugs or toxins; decreased awareness; additional indications for further assessment, such as abnormal vital signs — for example, a urinalysis may be ordered for an elderly patient with new-onset altered mental status and signs of urinary tract infection.


To combat opioid crisis, suburb will have overdose-reversing naloxone available in public places

From the Tribune:

Elk Grove Village will become one of the few towns in America to put overdose-reversing medication in public places, a key step in what Mayor Craig Johnson said will be a wide-ranging strategy to battle the opioid epidemic.

Johnson said at a news conference Thursday that the village will put kits containing the nasal spray form of naloxone in libraries, park district buildings and Village Hall, among other places. The village also wants to make the antidote widely available in schools and private businesses, similar to how defibrillators are placed in common areas.

Patient too large for MRI machine sues Oregon hospital for $7M

From Becker’s:

Portland, Ore.-based Providence St. Vincent Medical Center has been hit with a $7 million lawsuit by a patient who alleges he was initially sent home from the hospital because he was too large to fit inside the facility’s MRI machine, according to the Portland Business Journal.

Lawrence Jackson alleges in his medical negligence lawsuit that he was treated by Thomas Calverley, MD, at Providence St. Vincent Medical Center on Sept. 12, 2016. At that time, Mr. Jackson complained of mid-to-lower back pain, a sharp ache, a temperature of over 100 degrees, chills, appetite loss, and elevated pulse and blood pressure.

Dr. Calverley wanted to get an MRI of Mr. Jackson’s back. However, Mr. Jackson alleges he was sent home after the physician realized Mr. Jackson would not fit in the hospital’s MRI machine, according to the report.

Less than a week later, Mr. Jackson suffered a fall after his legs gave out and was taken by ambulance back to Providence St. Vincent. Dr. Calverley and a resident physician treated him in the emergency room. Mr. Jackson alleges he again complained of back pain.

Mr. Jackson’s lab results indicated the possibility of an infection, and a neurologist found he was unable to move his legs, according to lawsuit. He was transferred to Oregon Health & Science University Hospital in Portland, where he received an MRI and was diagnosed with a low thoracic epidural abscess.

Obesity rates surging in rural America

From CBS:

Country folk are being hit harder by the U.S. obesity epidemic than city dwellers, two new government studies show. Nearly 40 percent of rural American men and almost half of rural women are now statistically obese, U.S. Centers for Disease Control and Prevention researchers reported Tuesday.

And rural men, women and children are more likely to be severely obese than their counterparts from urban areas.

Further, rates of severe obesity in adults grew much faster in rural areas than metropolitan areas during the past decade and a half, said senior researcher Cynthia Ogden.